Cervical Spinal Stenosis

[Cameron Rogers]

I have recently been diagnosed with cervical spinal stenosis C4/5 and C5/6( initiated as the result of a severe whiplash trauma) and offered conventional surgery to correct it.(i'm chicken when it comes to surgery)  I am wondering about any microneurosurgical options available for correcting this problem? Either way, I am also wondering if when the surgeon knows the general area of the stenosis but is not sure about the precise location that is causing the problem, will he be able to remove bone all around the cord in order to be sure to remove the compression? If microneurosurgrey is done first and does not accomplish relief of symptoms would conventional surgery still be an option?  Here is my story:

Symptoms started 1-2 months after a severe blow to the head, front teeth knocked lose in whiplash like accident which occurred on the basketball court in which I slammed my front mandible teeth into another player

[Robert Lourea]

Over the past two years I have had cervical fusion at the 1,3, 5 level.  A plate was installed and removed three months later.  I had no relief and was unable to tolerate any form of therapy.  Most recently, in May,2000 I had a cervical lamenectomy of the 1 through 6 levels.  I am experiencing nausea, which comes and goes all day long.  (also experienced prior to surgery).  My neck is still very tight and sore and numbness in my right thigh. If I am standing for any length of time my leg experiences a burning sensation.  My internist believes the symptoms are all related to my neck but the surgeon disagrees. Can you give me any information or should I seek another opinion.

[Wes Staley]

What is ACF?

[Tracy Pautsch]

I have been told I have something wrong with my c-1 +c-2.  I have differnt days with different symptoms ranging from tightness in my left neck, muscle spasm on left shoulder, nausea, tingerling down left arm into hand, 10% numbness on left side of face, weakness on whole of left side, pain underneath left ear and jawline.  My chiropractor who is also a trained neurologist has seen x-rays and feels that not only do I have problems with c1+2 but I have a slightly jagged verterbrate in my neck which at times is pressing on my spinal nerve.  Can this happen?  Can there be breaks in the discomfort?  What is the outlook for this as it is ruining my life.  He told me he feels I had a slight whiplash injury 6 or 7 years ago.  On thinking I remember I was in a very slight car accident but had no problems then.  Can a person tell from an x-ray how old an injury is?

[CCF Neuro[P] MD, RPS]

Dear Ms Waggoner:

I think I would seek a second opinion from a neurosurgeon at a large institution, such as UCLA.  Your othro may be correct about your age and the extent of your problem, but I would still see if there was anything, like the vertebral glue procedure that you might safely undergo if the problem is a disc or compression.

Sincerely,

CCF Neuro MD

[Iona Waggoner]

I am 80 year old woman who has put up with severe back pain for the last 4 or 5 years.  It is worse when I stand or first wake up in the morning.  It radiates into my legs.  I have trouble walking and standing.  I've been on medication (oruvail, relifin and viox), I have had 3 epidurals (cortisone), 2 in the upper back and 1 into the tail bone region (mega dose).  I got temporary relief, but only for a couple of weeks.  The Rx medication caused stomach problems.  My orthopedic doctor doesn't recommend surgery because it would be too extensive and might not help.  I have scoliosis, arthritis & bone spurs.  I fractured my hip 3 years ago and have 3 screws in it and have done very well. I walk about a mile every morning.  I have good bone density and am in good health for my age.  I have had 3 MRI's in 4-5 years and the last one did not show much change since the previous one two years prior.  I have been told that I have thinning of the disks, i.e., bone rubbing on bone or compaction.  I've heard on television about a surgery to relieve back pain by removing bone from vertibray at the base of the neck.  Can you please tell me where to go for some pain relief.  I can't sit at home and wait to die, but I can't stand the cronic pain or the thought that I am destined to never find any relief.  I wear a belt around my waist with magnets in it, but that gives me only slight relief.

I appreciate your advice. IW, Orange County, California

[Iona Waggoner]

I am 80 year old woman who has put up with severe back pain for the last 4 or 5 years.  It is worse when I stand or first wake up in the morning.  It radiates into my legs.  I have trouble walking and standing.  I've been on medication (oruvail, relifin and viox), I have had 3 epidurals (cortisone), 2 in the upper back and 1 into the tail bone region (mega dose).  I got temporary relief, but only temporarily.  The rx medication caused stomach problems.  My orthopedic surgeon doesn't recommend surgery because it would be too extensive and might not help.  I have scoliosis, arthritis, bone spurs.  I fractured my hip 3 years ago and have 3 screws in it and have done very well.  I walk about a mile every morning.  I have good bone density and am in good health for my age.  I have had 3 MRI's in 4-5 years and the last one did not show much change since the previous one two years prior.  I have been told that I have thinning of the disks, i.e., bone rubbing on bone or compaction.  I've heard on television about a surgery to relieve back pain by removing bone from vertibray at the base of the neck.  Can you please tell me where to go for some pain relief.  I can't sit at home and wait to die, but I can't stand the cronic pain or the thought that I am destined to never find any relief.  I wear a belt around my waist with magnets in it, but that gives me only slight relief.

Thank you for your time. Iona Waggoner, Orange County, California

[Iona Waggoner]

I am 80 year old woman who has put up with severe back pain for the last 4 or 5 years.  It is worse when I stand or first wake up in the morning.  It radiates into my legs.  I have trouble walking and standing.  I've been on medication (oruvail, relifin and viox), I have had 3 epidurals (cortisone), 2 in the upper back and 1 into the tail bone region (mega dose).  I got temporary relief, but only temporarily.  The rx medication caused stomach problems.  My orthopedic surgeon doesn't recommend surgery because it would be too extensive and might not help.  I have scoliosis, arthritis, bone spurs.  I fractured my hip 3 years ago and have 3 screws in it and have done very well.  I walk about a mile every morning.  I have good bone density and am in good health for my age.  I have had 3 MRI's in 4-5 years and the last one did not show much change since the previous one two years prior.  I have been told that I have thinning of the disks, i.e., bone rubbing on bone or compaction.  I've heard on television about a surgery to relieve back pain by removing bone from vertibray at the base of the neck.  Can you please tell me where to go for some pain relief.  I can't sit at home and wait to die, but I can't stand the cronic pain or the thought that I am destined to never find any relief.  I wear a belt around my waist with magnets in it, but that gives me only slight relief.

Thank you for your time. Iona Waggoner, Orange County, California

[CCF Neuro[P] MD, RPS]

Dear Karen:

I am not sure what to tell you as I have no real knowledge of your spine.  I think that you should be able to talk to someone in the U.W. neurosurgeon's office.  If not, then maybe I would seek another opinion somewhere where at least they pay attention to you.  Maybe a collegue of his at UW or maybe someone in Portland at OHSU.  This type of surgery is difficult and rehab extensive so I would go where I feel the most comfortable with who is doing the surgery.  This is a commitment to not only the surgery but to the rehab as well.

If the ACF is really necessary, then I would go with the surgery. But find out for sure, now you have 2 opinions and they are different.  

Sincerely,

CCF Neuro MD

[Karen Morrell]

CCF Neuro MD
Further on above: I forgot to add that the neuro indicated that a discectomy would not be necessary. There is some deterioration
in the discs evident but not enough to warrent the operation for that reason alone. I thought this information would help you to make the comparison. Again, I appreciate any help you can give me.   KM

[Karen Morrell]

Dear CCF Neuro MD,
I took your advice and contacted the Spine Center at U of Washington Med school, They took my films, Dr. notes, labs etc and presented them to their group for evaluation. The MD assigned the case is a one of the neurosurgical directors of the center and a professor of neurosurg. I have talked to his assisant and she indicated that an ACF was indicated and that I should come in for an exam and schedule the surgery. When I asked about a cervical laminectomy she made a comment that a laminectomy was a part of a procedure and not a procedure in itself. This is not at all what was explained to us by the neurosurg. who recommended the laminectomy in the first place. We have tried to talk to the doc at U of W but since it is the major trauma center for the Northwest and he is in surgery four
days and seeing patients the fifth he apparently does not talk to patients on the phone. We live 750 miles from Seattle so would like to talk to him before committing to surgery of making the trip. Which brings me to my question to you. What in your opinion are the pros and cons between a ACF and a cervical laminectomy, assuming the condition is primarily a cervical stinosis at 4-5, 5-6 and 6-7. It is from anterior spondylitic disease as well as posterior ligmentous hypertrophy. No ongoing signs of myelopathy. Thanks for your help. Karen Morrell

[CCF Neuro[P] MD, RPS]

Dear Karen Morrell:

A teaching hospital at a major University Medical School would be a good place to start.  I would not see a new faculty member right out of training, see someone who has seen success and failure and then can comment on your specific condition.  I would not take any advise from someone who claims they always got good results.

CCF Neuro MD

[Karen Morrell]

I have been recently diagnosed with severe degenerative disc disease with osteophyte formation and multi-level cervical stenosis. (from MRI) I have seen two neurosurgions. One said an ACF C4-5, C5-6 & C6-7 was indicated and gave no other options. The second Dr. said he would do a cervical laminectomy and would not recommend ACF since I was young (57) and should not be faced with a fusion and that the possible degeneration in the spine above and below the fusion over my life expectancy was likely and would cause another operation down the road. I am leaning toward the laminectomy. He said I should be able to return to my former activities without restriction ie skiing. I am also thinking a third opinion is called for and am looking for a good place to get one in the Northwest.

[alan t]

I was diagnosed with cervical spinal stenosis  and 2 herniated discs wwith osteopyts putting pressure on the cord. In the last   3years I have had 2 surgurys(disectomy;decompression lamenectomy in 3levels). a recent mri revealed that the same discs were herniated again and that the stenosis was only improved on 1 level.  Can  I still have a cervical corpectomy?It has been 3 months since the lamenectomy with little improvement of  my symptoms.

[CCF Neuro[P] MD, RPS]

No,

CCF Neuro MD

[Cameron Rogers]

I can eliminate my pain almost totally by closing the right eye and the pain goes away behind the left eye and what little I have behind the right eye.  Is it possible for the brain to be receiving visual input from the seperate eyes at different speeds and this creates the sensation of retro-orbital eye pain and what I term visual overstimulation?

Here is an interesting web site which deals with the complex of symptoms that I am experiencing:

http://www.clipper:net/~calder/POTSWEB.html

[CCF Neuro[P] MD, RPS]

Dear Cameron Rogers:

The questions you ask are very consuming and probably not the best for a forum such as this.  You really need to see your neurologist and sit down and talk over these questions with someone who has visualized the films and examined you.  A forum such as this can not possible give justice to the extend of your many questions.

As far as micro-surgery on your cord compression.  That would be a neurosurgical decision based on the extent of the compression.  The axial cuts of the MRI should be able to give the neurologist and the neurosurgeon an adequate view of this and they should have no problem telling you the extend of the compression.  Each surgeon is variable on what he/she feels most comfortable procedure-wise and that is their decision.  The extent of your compression would indicate a non-micro type of surgery would be necessary.

I am not aware of separate "signals" that reach the orbits.  The eye is innervated by dual pathways that usually function in together, or yoked together.  Whoever told you this should explain this to you.  The only input to the eye from the spinal cord is from the sympathetic system, from the upper cervical ganglion.  This supplies the size of the pupil, sensation of the face, sweat glands of the face, and the eye lid muscles.  So, since you did not mention any of these symptoms, I find it hard to answer your question.  There is an entity called occipital neuraglia that is due to pinching of the nerve that innervates the occipital region of the head and can radiate to the orbit area.  We treat this type of headache with indomethacin and a soft neck collar while at sleep.

I am not sure what you mean by overstimulation of the eye.  I am also unsure of what your mean by stenoic point?  A chiari malformation might induce headache but not eye problems unless it was causing hydrocephalus or increased ICP.  The type of headache you describe is not this type of headache.  Whether or not your chiari is a true chiari or not remains for the neurologist to tell you as he/she has reviewed the MRI.  

SVT is not treated by serotinin uptake inhibitors.  This is done by either cardioversion or adenosine if there are circulatory compromised due to the SVT.  Again, I am not sure what you are asking.  Usually SVT is not caused by the sympathetic system or parasympathetic system.  It is usually an aberrant pathway in the heart that is triggered by inappropriate stimulation.  I would suggest that you see a cardiologist about this problem.

Postural orthostatic tachycardia would not cause increased CSF flow.  This is related to the change of position of your body and the heart compensating with increase blood flow to the heart (supine to standing) by increasing heart rate and blood pressure.  Floaters in the viteous portion of the lens has nothing to due with this.  Many people have floaters.

The flashing of light that you see is very worrisome.  I would see an opthalmologist and see if you might have a retinal tear.  Flashes of light are not due to altered "signals" but usually are the retinal cells firing on their own as they are dysfunctioning.  

I am not sure what to tell you about interolance to heat.  This may be related to a thyroid problem, but will need to be worked up and investigated by your local physician.

The tingling, fatigue, and mild balance problem are very broad  symptoms and occur with a wide variety of diseases.

Taking all your symtpoms together, I really think that you need to see a neurologist and get a full workup.  See an opthalomologist and get your eyes examined thoroughly.  

Sincerely,

CCF Neuro MD